P1323: THE PROGNOSIS AND COMPLICATIONS OF PATIENTS WITH PRE-TRANSPLANT LIVER DYSFUNCTION
Authors: Yukiko Misaki, Masaharu Tamaki, Ryu Yanagisawa, Noriko Doki, Takahiro Fukuda, Naoyuki Uchida, Masatsugu Tanaka, Yukiyasu Ozawa, Masashi Sawa, Takahide Ara, Junya Kanda, Yoshiko Atsuta, Yoshinobu Kanda, Hideki Nakasone
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: The hematopoietic cell transplantation comorbidity index (HCT-CI) score including hepatic dysfunction is known to be related to clinical outcomes after allogeneic hematopoietic cell transplantation (HCT). HCT for recipients with hepatic dysfunction (liver HCT-CI-positive group) is often performed in clinical practice. However, it has yet to be elucidated what kind of complications are specifically observed in the liver HCT-CI-positive group. Aims: We aimed to reveal the features in complication profiles and causes of death among the liver HCT-CI-positive group. Methods: Using the Japanese transplant registry database, we retrospectively assessed the impact of the positivity of HCT-CI liver score on clinical outcomes among recipients who received their 1st allogeneic HCT between 2010 and 2020. For recipients to be considered eligible, information on the HCT-CI score was required. In addition, we selected low- or standard-risk patients. All recipients in this study were limited to those with cyclosporine or tacrolimus-based prophylaxis for graft-versus-host disease (GVHD). We excluded recipients with >=1 of HCT-CI comorbidities without any liver HCT-CI score, for the purpose of clarifying the impact of hepatic dysfunction on clinical outcomes. This retrospective analysis was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board at Jichi Medical University Saitama Medical Center. Results: Among 14283 recipients, 1534 tested positive for liver HCT-CI score. The 5-year overall survival (OS) was significantly lower in the liver HCT-CI-positive group (59.4% vs 65.5%, P<0.001), and the 5 year NRM was higher in the liver HCT-CI-positive group (26.3% vs 19.4%, P<0.001). Multivariate analyses confirmed the adverse impact of the presence of liver HCT-CI score (HR for OS, 1.21(, P<0.001; HR for NRM: 1.30, P<0.001). Focusing on the detail of complications, platelet recovery (>5x10^10/L) was significantly delayed in the liver HCT-CI-positive group (70.3% vs. 78.6%, P<0.001; HR 0.86, P<0.001), while bacterial infections (51.5% vs 46.8%, P<0.001; HR 1.10, P=0.015), aspergillus infection (1.5% vs 0.9%, P=0.019; HR: 1.45, P=0.0045), and CMV reactivation (47.3% vs 42.2%, P<0.001; HR:1.09, P=0.039) were significantly higher in the liver HCT-CI -positive group. Looking at the cause of death, the incidence of fatal hepatic problems in the HCT-CI liver positive group seemed to be higher than that in the control group (5.5% vs 3.4%). In addition, the incidence of fatal infection also seemed to be higher in the liver HCT-CI-positive group (24% vs 21%). Summary/Conclusion: Liver HCT-CI positivity was significantly associated with an increased risk of mortality. Especially, the liver HCT-CI-positive group frequently experienced bacterial and aspergillus infections and CMV reactivations, leading to the inferior OS and NRM. We should further take caution on infectious events in recipients with hepatic dysfunction.Keywords: Comorbidities, Liver, Complications, Allogeneic hematopoietic stem cell transplant